FUNCTIONAL IMPACT ON ADULTS AND OLDER PEOPLE AFTER HOSPITALIZATION BY COVID-19

Abstract Cross-sectional study of 159 individuals, one month after hospitalization at the Hospital das Clínicas of the University of São Paulo for Covid-19, divided into groups: 54.7% (n=87) were adults (< 60 years), and 45.3% (n=72) were older people (≥60 years), with 43.4% (n=69) being female. Those who did not accept to participate, without availability, or without ability to understand the questionnaires were excluded. Functional capacity was assessed by the Barthel Index (BI). Statistical analysis was performed using JASP Statistics-0.15.0, considering significance level of alpha=0.05. Wilcoxon and Mann-Whitney tests were applied to compare pre- and post-Covid periods and to compare adults and older people, respectively. Data collection went from June 30, 2020, to August 24, 2021. The median length of hospitalization was 23 (15-34) days. The median total BI scores were lower one month after discharge in older people, 95 [90-100], when compared to adults, 100 [92.5-100] (p=0.001). Bladder control (p=0.009), toilet use (p=0.021), chair/bed transfers (p=0.043), ambulation (p=0.006), dressing (p=0.015), stair climbing (p< 0.001), and bathing self (p=0.006) were the activities of daily living most affected in older people. Hospitalization due to Covid-19 had functional impacts in the post-discharge period, particularly in older people, manifested by limitations in performance of daily activities with higher physical demand. These findings emphasize the need for functional capacity screening after hospitalization for Covid-19, especially in older people.

Few studies have investigated the association between frailty and subsequent body composition.We performed separate linear mixed model analyses in 996 adults (mean age at baseline[SD]: 61.5[2.9]) in a Finnish longitudinal birth cohort study to explore the relationships between changes in frailty status assessed by the Rockwood 41-item-frailty-index (FI) and changes in body mass index (BMI), lean mass index (LMI), fat mass index (FMI), and FMI to LMI-ratio values during 17 years of follow-up.With advancing age, LMI and BMI decreased, whereas FMI and FMI to LMI -ratio increased.Those who were frail (FI≥ 0.25) already at baseline, followed by those who became frail during the follow-up, experienced faster decreases in LMI and faster increases in FMI and FMI to LMI -ratio values relative to those who were 'never frail'.Contrastingly, those in the highest third of absolute annual increase in FMI and FMI to LMI-ratio became frailer faster over time relative to those in the lowest third.We found evidence of an adverse health outcome of frailty where lean indices declined faster and fat indices and fat to lean -ratios increased faster from midlife into old age.The changes resembled those that occurred with aging, but at a faster pace.The relationship between body composition and frailty is likely bidirectional, where high or increasing levels of fat are associated with the risk of becoming frailer earlier, but where a longer duration of frailty may increase the risk of faster age-related changes to body composition.
the patient-level measures after the intervention.Interview participants shared that their work environment affects their mindset and workflow, limiting their capacity to deliver the type of care presented in the education sessions.Staff identified the need for specialized education; however, there was no impact on care after participation.Environmental constraints hindered staff from implementing best practices, leading to both practical and psychological challenges to care delivery.These results will inform changes to specialized education programming with the aim of improving care for older adults in hospital.It is impossible to consider personal transportation in the United States without engaging with the topic of driving.Over 90% of U.S. households own cars, while 83% of people report they drive several times a week.A critical but often overlooked component of the driving narrative particularly among older adults is the decision of when or if to forfeit the car keys, a topic which is both complex and, for many individuals and families, a source of stress and conflict.With a rapidly growing population of the oldest of older adults, the 85+ age demographic, it is crucial to understand the attitudes and behaviors of this diverse age group regarding the experience of driving retirement.Utilizing four semi-structured focus groups (n=17) and a 48-item survey of original and adapted measures (n=34) with a panel of the 85+, this study sought to understand people's perspectives on driving, how current drivers think about and plan for driving retirement -or not, and participants' general perceptions and attitudes toward the future of technology and driving.The data suggest four different vignettes or transportation paths with respect to driving among this age group that intersect with themes of autonomy, the experience of physical aging, the role of family, and key inflection points.Implications of this research highlight the need for targeted solutions and materials for people at varying levels of acceptance with their driving stage and underscore the need for more research and greater involvement of different stakeholders in conversations around transportation and aging.Cross-sectional study of 159 individuals, one month after hospitalization at the Hospital das Clínicas of the University of São Paulo for Covid-19, divided into groups: 54.7% (n=87) were adults (< 60 years), and 45.3% (n=72) were older people (≥60 years), with 43.4% (n=69) being female.Those who did not accept to participate, without availability, or without ability to understand the questionnaires were excluded.Functional capacity was assessed by the Barthel Index (BI).Statistical analysis was performed using JASP Statistics-0.15.0, considering significance level of alpha=0.05.Wilcoxon and Mann-Whitney tests were applied to compare pre-and post-Covid periods and to compare adults and older people, respectively.Data collection went from June 30, 2020, to August 24, 2021.The median length of hospitalization was 23 (15-34) days.The median total BI scores were lower one month after discharge in older people, 95 [90-100], when compared to adults, 100 [92.5-100] (p=0.001).Bladder control (p=0.009),toilet use (p=0.021),chair/bed transfers (p=0.043),ambulation (p=0.006),dressing (p=0.015),stair climbing (p< 0.001), and bathing self (p=0.006) were the activities of daily living most affected in older people.Hospitalization due to Covid-19 had functional impacts in the post-discharge period, particularly in older people, manifested by limitations in performance of daily activities with higher physical demand.These findings emphasize the need for functional capacity screening after hospitalization for Covid-19, especially in older people.
Abstract citation ID: igad104.3365The hospice philosophy of care (HPOC) is a set of values applicable to all interdisciplinary group members that drives organizational and individual approaches to hospice care.As the only established measure of HPOC attitudes, we aimed to extend previous exploratory psychometric evaluation of the eight-item Hospice Philosophy Scale (HPS-8).An interdisciplinary convenience sample of 481 hospice clinicians participated in this cross-sectional study.Participants were recruited through hospice and palliative care membership associations representing the core members of the Medicare Hospice Benefit-designated hospice interdisciplinary group (physicians, nurses, social workers, chaplains).After examining uniformity through confirmatory factor analysis, we tested HPS-8 items for differential item functioning (DIF) by professional discipline using multiple indicators, multiple causes models.We compared models via nested chi-square difference tests.Our final model assessed uniform DIF for the HPS-8 factor, controlling for DIF-indicated items.We also assessed internal consistency reliability.After correlating errors for two similarly worded items, global fit indices met prevailing thresholds, χ²(19)=55.18,p<.001 (RMSEA=.06,SRMR=.03,CFI=.98,TLI=.97).The uniform DIF model indicated two items with DIF.Chaplains endorsed the need for mental and spiritual preparation for death more than physicians (β=0.21,p<.001).Nurses endorsed involving patients and families in deciding treatments and services more than physicians (β=0.21,p=.006).Despite statistically significant DIF on these items, statistically significant differences among professions were not observed at the factor level (p>.50 for all).Composite reliability estimates satisfied internal consistency thresholds (CR=.76).Results support the HPS-8's use as a valid and reliable measure for assessing HPOC in hospice clinicians.

FURTHER EVALUATION OF A MODIFIED VERSION OF THE HOSPICE PHILOSOPHY SCALE: A DIFFERENTIAL ITEM FUNCTIONING ANALYSIS
Abstract citation ID: igad104.3366

GDF15 AND REDUCED PHYSICAL FUNCTION FOLLOWING TOTAL KNEE REPLACEMENT: A STUDY OF PHYSICAL RESILIENCE AND AGING
William Fountain 1 , Nicholas Milcik 1 , Nicholas Schmedding 1 , Frederick Sieber 1 , Julius Oni 1 , Ravi Varadhan 2 , Karen Bandeen-Roche 1 , and Jeremy Walston 1 , 1. Johns Hopkins University, Baltimore, Maryland, United States, 2. Johns Hopkins University School of Medicine, Baltimore, Maryland, United States The metabolic and inflammatory cytokine growthdifferentiation factor 15 (GDF15) increases with age and negatively associates with physical and cognitive function in older adults.We hypothesized GDF15 also negatively associates with resilient outcomes after surgery.This hypothesis was tested in the SPRING study of physical resiliency after total knee replacement by assessing relationships between pre-operative plasma GDF15 levels and postoperative resilience measures including short physical performance battery (SPPB) scores, fatigability, and grip strength.GDF15 analyses and physical resilience were assessed in 127 SPRING participants (age 70±6 yrs, n=83 women).Baseline GDF15 levels correlated with age (r=0.263,P< 0.05); age-adjusted analyses were applied.In total, pre-operative GDF15 levels did not significantly correlate with functional measures at any timepoint.However, in men (n=44), GDF15 levels correlated with age (r=0.408,P< 0.05) and significant age-adjusted correlations were observed in fatigue (r=0.368,P< 0.05), gait speed (r=-0.428,P< 0.05), and SPPB score (r=-0.329,P< 0.05).Additionally, GDF15 levels correlated with chair stands at six months (r=-0.398,P< 0.05), SPPB score at six months (r=-0.384,P< 0.05), and gait speed after one year (r=-0.487,P< 0.05).GDF15 did not significantly correlate with changes in SPPB score (P>0.05).There were no significant correlations between GDF15 and any of these functional measures in women (r-value range: -0.259 to 0.107; p-value range: 0.112 to 0.969).Elevated pre-operative GDF15 appears to correlate with worsening physical function following knee replacement in men, but not women.Further investigation is necessary to understand the relationship between GDF15 and the biology of physical resiliency.